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Question 1

A 9-month-old male infant presents with a 3-day history of high-grade fever, irritability, and poor feeding. On examination, he is lethargic, hypotonic, and has a bulging anterior fontanelle. Nuchal rigidity is equivocal. Lumbar puncture reveals cerebrospinal fluid (CSF) with 1200 white blood cells/µL (85% neutrophils), protein 180 mg/dL, and glucose 18 mg/dL (serum glucose 90 mg/dL). Gram stain shows Gram-negative coccobacilli. Despite prompt initiation of broad-spectrum antibiotics, the infant develops hydrocephalus and severe developmental delay. Which of the following is the most likely long-term neurological sequela directly attributable to the organism causing this infection?

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Question 2

A 3-year-old unimmunized child presents with a 1-week history of malaise, low-grade fever, and a sore throat. Over the last 24 hours, he developed progressive difficulty swallowing, noisy breathing, and a 'bull neck' appearance. On examination, a greyish, adherent membrane is noted on the tonsils and pharynx, extending to the soft palate. Lymphadenopathy is prominent bilaterally. Given the high suspicion of a specific infectious disease, which of the following is the most critical immediate management step, assuming airway patency is currently stable but compromised?

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Question 3

A 5-year-old child from a rural area presents with a 2-day history of fever, headache, and myalgia, followed by a maculopapular rash that appeared first on the face and behind the ears, then spread centrifugally to the trunk and extremities, including palms and soles. The rash is non-itchy. He also has prominent post-auricular and posterior cervical lymphadenopathy. On examination, his conjunctivae are mildly injected. There are no Koplik spots. The child’s mother is 8 weeks pregnant and has not received any childhood immunizations. Which of the following is the most appropriate advice for the mother regarding her pregnancy outcome?

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Question 4

A previously healthy 6-month-old infant presents with a 3-week history of persistent cough and episodes of paroxysmal cough followed by inspiratory 'whoops' and post-tussive emesis. The infant is unimmunized. Physical examination reveals conjunctival hemorrhages and subconjunctival petechiae. Nasopharyngeal swab culture subsequently grows Gram-negative coccobacilli. Despite appropriate antibiotic therapy, the infant experiences apneas requiring intensive care unit admission. Which of the following laboratory findings is most characteristic of this condition and directly contributes to its severity?

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Question 5

A 7-year-old boy presents with sudden onset of high fever, severe headache, photophobia, and neck stiffness. On examination, he is drowsy, and Kernig's and Brudzinski's signs are positive. Lumbar puncture reveals CSF with a white blood cell count of 350 cells/µL (80% lymphocytes), protein 90 mg/dL, and glucose 55 mg/dL (serum glucose 95 mg/dL). Gram stain is negative. An MRI of the brain shows subtle T2 hyperintensities in the temporal lobes. The child has a recent history of swimming in a freshwater lake. Which of the following is the most likely pathogen?

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